Combination of Doppler and amniotic fluid assessment to predict adverse perinatal outcomes in intrauterine growth restriction

Combination of Doppler and amniotic fluid assessment to predict adverse perinatal outcomes in intrauterine growth restriction

Fetal or intrauterine growth restriction (IUGR) is one of the most common obstetric complications during pregnancy. And it is associated with a fetal mortality that can reach 50%. The great challenge in the management of these cases is to define the moment appropriate resolution of the pregnancy, balancing the risks of prematurity and fetal death.

The etiology of IUGR is diverse, from maternal and fetal factors; however, the final common pathway is placental insufficiency. The analysis of this placental insufficiency and the consequent fetal well-being is done through the Doppler study, with some of the most common measurements: the pulsatility index (PI) of the uterine, middle cerebral (IPACM) and umbilical (IPAUMB) arteries, in addition to the brain-placental (CPR).

In addition to Doppler, another ultrasound assessment of fetal well-being is amniotic fluid volume, assessed both by measuring the largest pocket (MB) and by the amniotic fluid index (AFI).

The article described here was recently published in the International Journal of Gynecology and Obstetrics and analyzed a relationship between amniotic fluid and fetal Doppler to predict unfavorable perinatal outcomes in restricted fetuses.

The index analyzed by the authors was the combination of the measurement of the largest pocket with the Doppler relationship of the umbilical artery with the cerebral artery, being named amniotic-umbilical-to-cerebral ratio (AUCR). This index was calculated as the division of the largest pocket by the IPAUMB/IPACM ratio (UCR).

The study

This is a prospective cohort study, developed in a tertiary center in Turkey. The research subjects were composed of pregnant women between 18 and 40 years old, hospitalized at the study center, diagnosed with IUGR after 37 weeks. A fetus with an estimated fetal weight < p10% was considered to be IUGR.

Unfavorable perinatal outcomes were umbilical cord pH <7.1, 5-minute Apgar score <7, and intensive care unit (ICU) admission.


We analyzed 100 women from 2020 to 2021. They were divided into two groups according to the presence or absence of an adverse perinatal outcome. The control group had 83 women, while the study group had 17.


IPAUMB and UCR index were significantly higher in the study group (1.18 ± 0.4 vs. 0.91 ± 0.19 and 1.1 ± 0.34 vs. 0.72 ± 0.31, p = 0.015 and p = < 0.001), while MB, CPR and AUCR were significantly lower (3.1 ± 1.1 vs. 4.0 ± 1.3, 1.4 ± 0.6 vs. 4.5 ± 2.8 and 3.0 ± 1.1 vs. 7.1 ± 3.9, p = 0.018, p = 0.002, and p = < 0.001).

In addition to this comparison, ROC curves were constructed for each Doppler index and the index with the largest area under the curve was the AUCR (0.882).

Read too: ABRAN Consensus presents DHA recommendations during pregnancy, lactation and childhood

practical message

In view of these findings, the authors suggest that the AUCR index (ratio of the largest pocket with the umbilical artery/cerebral Doppler) is the ultrasound index among those studied that was most associated with adverse perinatal outcomes, being the best predictor among them.

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